The House and Senate are considering a step so improbable it deserves more public attention than it has gotten.
They are considering a bipartisan compromise to overhaul Medicare. They may even approve it this week.
Let me repeat: Congress may approve a bipartisan compromise to overhaul Medicare.
No, it’s not a comprehensive answer to Medicare’s long-term financing woes. It’s a modest proposal, slightly more than $200 billion over 10 years, to end the now-familiar charade over whether doctors treating Medicare patients would receive periodic rate increases—as they always did in the end.
Yet the deal shepherded by House Speaker John Boehner and Democratic leader Nancy Pelosi carries power just the same. It would buck the popular impression that Washington can’t accomplish anything at all. It also would provide a template for deals on other issues, if only Republicans and Democrats were willing to use it.
Democrats agreed to accept spending cuts affecting health care providers like rehabilitation hospitals and skilled nursing facilities. The “Medigap” policies some seniors buy to supplement Medicare would be barred from covering their deductibles for doctor visits, since deductibles help restrain consumption of health services.
Republicans agreed to accept revenue increases. They not in the form of tax increases, but rather in the form of Medicare premiums for beneficiaries with incomes above $133,500.
And both parties agreed to add two-thirds of the package’s cost to the federal deficit—setting aside the insistence on “budget neutrality” that they sometimes invoke selectively to block priorities of the other side. Requiring tax or spending “offsets” to cover all the cost, rather than just $70 billion of it, would have sunk the package.
There are good reasons that Republicans and Democrats laid down some of their traditional political weapons in this case. Lawmakers have grown weary of repeatedly being forced to pass “doc fix” bills to overcome restraints on doctor fees from a 1997 deficit reduction bill that hasn’t worked as intended by then-President Bill Clinton and the GOP Congress.
In 21st century Washington, of course, good reasons are often insufficient to propel what once was the routine business of government. Typically only the raw compulsion of statutory deadlines does the trick anymore.
And the trick is not done yet. Senate Democrats have questioned one component that would extend the Children’s Health Insurance Program—another Clinton-era accomplishment—for two years instead of the four they prefer. Some also believe it contains unjustifiable language restricting the use of government funds to pay for abortion. Some conservative groups have urged “no” votes on grounds of fiscal irresponsibility.
For those objections to scuttle the deal would merely amount to one more dreary dog-bites-man political tale from the capital.
Yet odds still favor passage. The House plans to vote Thursday, and leadership aides predict solid support from Republican and Democratic members alike.
Large bipartisan House majorities can have a strong influence on the Senate, which will either pass it swiftly or postpone debate until after a two-week recess. In either case, Democratic holdouts can’t easily shrug off the twin support of Pelosi and President Barack Obama, who formally backed the deal Wednesday afternoon.
If it happens, both parties will have something to brag about. And plenty of Americans beyond the doctors whose incomes grow more secure will have cause to believe their government sometimes actually works.